Is laparoscopic right colectomy more effective than open resection? A meta‐analysis of randomized and nonrandomized studies

Rondelli, Fabio; Trastulli, Stefano; Avenia, Nicola; Schillaci, Giuseppe; Cirocchi, Roberto; Gullà, N; Mariani, E.; Bistoni, Giovanni; Noya, Giuseppe

doi:10.1111/j.1463-1318.2012.03054.x

Cited by 79 publications

(38 citation statements)

References 55 publications

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“…LTME appears to have clinically and oncologically measurable advantages over OTME in patients with primary resectable rectal cancer in both short term and long term follow ups. The findings of this article are consistent with previously published Cochrane review and a meta-analysis [43,44] . Majority of the studies in the Cochrane review [44] were non-randomized, trials and therefore the conclusion was considered weaker and biased.…”

Section: Anastomosis By Knight-griffen Techniquesupporting

confidence: 82%

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Systematic review of oncological outcomes following laparoscopicvsopen total mesorectal excision

Sajid

Ahamd

Miles

et al. 2014

WJGE

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AIM:To systematically analyze the randomized trials comparing the oncological and clinical effectiveness of laparoscopic total mesorectal excision (LTME) vs open total mesorectal excision (OTME) in the management of rectal cancer. METHODS:Published randomized, controlled trials comparing the oncological and clinical effectiveness of LTME vs OTME in the management of rectal cancer were retrieved from the standard electronic medical databases. The data of included randomized, controlled trials was extracted and then analyzed according to the principles of meta-analysis using RevMan ® statistical software. The combined outcome of the binary variables was expressed as odds ratio (OR) and the combined outcome of the continuous variables was presented in the form of standardized mean difference (SMD). RESULTS:Data from eleven randomized, controlled trials on 2143 patients were retrieved from the electronic databases. There was a trend towards the higher risk of surgical site infection (OR = 0.66; 95%CI: 0.44-1.00; z = 1.94; P < 0.05), higher risk of incomplete total mesorectal resection (OR = 0.62; 95%CI: 0.43-0.91; z = 2.49; P < 0.01) and prolonged length of hospital stay (SMD, -1.59; 95%CI: -0.86--0.25; z = 4.22; P < 0.00001) following OTME. However, the oncological outcomes like number of harvested lymph nodes, tumour recurrence and risk of positive resection margins were statistically similar in both groups. In addition, the clinical outcomes such as operative complications, anastomotic leak and all-cause mortality were comparable between both approaches of mesorectal excision.CONCLUSION: LTME appears to have clinically and oncologically measurable advantages over OTME in patients with primary rectal cancer in both short term and long term follow ups.

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Section: Anastomosis By Knight-griffen Techniquesupporting

confidence: 82%

“…Majority of the studies in the Cochrane review [44] were non-randomized, trials and therefore the conclusion was considered weaker and biased. Similarly a recently published meta-analysis [43] failed to demonstrate the oncological safety and advantages of LTME over OTME.…”

Section: Anastomosis By Knight-griffen Techniquementioning

confidence: 99%

Systematic review of oncological outcomes following laparoscopicvsopen total mesorectal excision

Sajid

Ahamd

Miles

et al. 2014

WJGE

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“…Also, as is usual for laparoscopic colorectal surgery, the operation time is longer than that required for open surgery. This does not diminish the general advantages of laparoscopic colorectal surgery in general and also not in our series, as demonstrated by the shorter hospital stay [9][10][11][12]. Another disadvantage of the procedure is that we need rather a lot of large bore (10 and 12 mm) ports.…”

Section: Discussionmentioning

confidence: 92%

“…This holds true not only for left but also for right hemicolectomy [11,12]. For a long time, right hemicolectomy has been considered to be a beginner's procedure in colorectal surgery because of its low complexity.…”

Section: Discussionmentioning

confidence: 95%

The uncinate process first approach: a novel technique for laparoscopic right hemicolectomy with complete mesocolic excision

Benz

Tam²,

Tannapfel³

et al. 2015

Surg Endosc

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Laparoscopic right hemicolectomy with CME using the UFA provides adequate radicality according to the CME principles and seems feasible and as safe as an open technique. However, future trails will have to demonstrate whether the theoretical advantages of the UFA, with a higher degree of mobility and accessibility of the mesenteric root, translate into a significant clinical benefit, especially relative to the other laparoscopic techniques.

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“…Conversely, some recent studies have shown that mortality and morbidity were significantly lower after laparoscopic right-sided colectomy compared to mortality and morbidity after open surgery [12, 13]. …”

Section: Introductionmentioning

confidence: 99%

Minimally Invasive versus Open Approach for Right-Sided Colectomy: A Study in 12,006 Patients from the Dutch Surgical Colorectal Audit

Bosker¹,

Riet²,

Noo³

et al. 2018

Dig Surg

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Background: There is ongoing debate whether laparoscopic right colectomy is superior to open surgery. The purpose of this study was to address this issue and arrive at a consensus using data from a national database. Methods: Patients who underwent elective open or laparoscopic right colectomy for colorectal cancer during the period 2009–2013 were identified from the Dutch Surgical Colorectal Audit. Complications that occurred within 30 days after surgery and 30-day mortality rates were calculated and compared between open and laparoscopic resection. Results: In total, 12,006 patients underwent elective open or laparoscopic surgery for right-sided colorectal cancer. Of these, 6,683 (55.7%) underwent open resection and 5,323 (44.3%) underwent laparoscopic resection. Complications occurred within 30 days after surgery in the laparoscopic group in 26.1% of patients and in 32.1% of patients in the open group (p < 0.001). Thirty-day mortality was also significantly lower in the laparoscopic group (2.2 vs. 3.6% p < 0.001). Conclusion: In this non-randomized, descriptive study conducted in the Netherlands, open right colectomy seems to have a higher risk for complications and mortality as compared to laparoscopic right colectomy, even after correction for confounding factors.

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Is laparoscopic right colectomy more effective than open resection? A meta‐analysis of randomized and nonrandomized studies

Abstract: Laparoscopic-assisted right colectomy results in less blood loss, a shorter length of hospital stay and lower postoperative short-term morbidity compared with ORC.

Cited by 79 publications

References 55 publications

Systematic review of oncological outcomes following laparoscopicvsopen total mesorectal excision

Systematic review of oncological outcomes following laparoscopicvsopen total mesorectal excision

The uncinate process first approach: a novel technique for laparoscopic right hemicolectomy with complete mesocolic excision

Minimally Invasive versus Open Approach for Right-Sided Colectomy: A Study in 12,006 Patients from the Dutch Surgical Colorectal Audit

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